The many years I have worked in occupational health often led me to work with Managers who hated the idea of a phased return to work or rehabilitation programme. For example, home care managers in social services, without exception, always told me to get workers back to work fully fit or not at all. Even though I explained the benefits. The problem in home care, they said, was if they couldn’t do manual handling, then there was no work for them. I disagreed and pointed out that those on a phased return could work with others (they usually worked alone), help with training, supervise new workers, work in the office, or be redeployed to another part of the Council until they were fully fit. This happened rarely.
Today with the new option on the fitness for work certificate (formerly sick note) for a phased return to work, my work is somewhat easier as phased returns are now a written option on the fit note.
The Fit Note
GP’s now issue workers with fit notes (formerly sick notes) looking at keeping people at work or getting them in the workplace earlier, the subtle change from negative ‘sick’ note and ‘fit’ note reflects new thinking in health at work.
The Fit Note has the following options available:
- Not fit for work
- May be fit for work taking into account the following
- Phased return
- Altered hours
- Amended duties
- Workplace adaptations
The assessment of whether your employee is not fit for work or may be fit for work (and any other advice in the fit note) is classed as advice, and you decide whether to accept the GP’s advice or not.
For more advice on the Fit Note, go to the Government guidance booklet for Employers
Phased Return to Work
A phased return to work is usually suggested after sickness absence longer than 4 weeks. It gives employees a way of coming back to work before they are fully fit. They do fewer hours and duties adapted so full recovery takes place at work in a stepped way. For many workers though, the options above are blurred, as a phased return could also be called altered hours or amended duties. Due to this, I will deal with phased returns in a generic sense and not a literal one.
So which option suits your needs best? Are you the type of manager that embraces the phased return approach or one that prefers the ‘stay at home till your fully fit to return to work’?
The decision you make is important. For each choice has consequences, for example, returning a person to work early means they are earning their pay but you will do more too. You need to supervise and review the employee more.
To help you weigh up the options, I have set out a Managers pros and cons of phased returns to work to help you decide.
Advantages of a Phased Return
- Employees build their strength, capacity and tolerance to work in a stepped way and not staying at home until they are totally fit. This type of programme is especially helpful after long-term sickness when there has been a serious health incident. Also helpful where work is strenuous or demanding e.g. high volume workload in an office environment where mistakes could be costly to you.
- The potential for reducing costs by getting people back to work earlier and reducing the need for other workers to cover their work.
- Company sick pay schemes usually allow full pay for sick absence, by implementing an early return to work you are able to get some value from the phased return.
- Employees return much earlier and settle back down into normal life, which improves their overall well-being.
The Management of Health and Safety Regulations sets out the principles of risk assessment which is especially relevant for a safe return to work after illness and must form part of the phased return plan.
The Equality Act is relevant for the disabled as defined by the Act and who may need to be redeployed temporarily or permanently.
The Regulatory Reform (Fire Safety) Order requires employers or organisations providing services to the public take responsibility for ensuring that all people, including disabled people, can leave the building they control safely in the event of a fire. In order to comply with legislation, a Personal Emergency Evacuation Plan (PEEP) needs drafting for each returnee especially if there are mobility issues.
- Employees have a personal structured phased return to work specific to themselves, their work and their capabilities agreed with you
- The way workers are treated whilst off sick has a huge impact on how they view the company and you, so this type of programme improves the overall positive culture and morale of the company.
- The UK workforce is ageing which makes long-term illness more likely; a phased return to work plan will encourage workers to return to work and not retire early
Disadvantages of a Phased Return
- Phased returns involve more managerial response as you have to draft and agree on the work programme. Meetings take time as you monitor how the return to work is going and next steps.
- Difficulties occur due to problems with recovery or relapse. If this happens, discuss progress with the individual and adjust the phased plan as necessary. This can become frustrating especially if recovery slows down. In rare cases, recovery never happens. Bear this in mind when setting up the phased return, discuss this openly with the worker, and you will be able to spot the signs early.
- You might be unsure of the medical facts if you don’t have an occupational health service. Also, staff may go into embarrassing details about their health.
- You believe that the worker is trying to get one over on you or that the rehabilitation programme will become permanent.
- Rehabilitation programme are more difficult to start in jobs where safety issues impact on work or in smaller companies, as there are fewer options available for adjustment.
- The GP may not agree with what you are suggesting
- Paying workers becomes difficult when they are doing reduced hours, also counting days off sick. If all goes well it won’t be a problem but there could be issues if this is not agreed up front.
How can Occupational Health services help
One way to get over most of the disadvantages listed above is to talk to or engage an occupational health service. Occupational health services provide objective and independent advice on what would be an appropriate return to work programme using the phasing method for an individual.
There are also national helplines and websites for managers and HR to use, to see the details on the fit for work service, which charts how the scheme is working (September 2017).
The assessment by occupational health considers the health incident and recovery rate of a worker, making suggestions of what this might be. The phased return to work plan may also contain other recommendations to start with, such as reduced lifting, standing, or even travelling during the working day. Occupational health professionals understand both the health issue and the workplace; recommendations are practical and take into account the business needs as well as the individual’s capability and motivation for returning to work. More importantly, having your own occupational health service means there is less delay and likely reduce your input.
If you use an occupational health service, managers will be given full advice on your involvement, how the programme should progress and a likely date when full contractual duties are resumed. In more complicated cases occupational health will write to the workers own specialists and GP’s for specific health advice.
Phased return plan
The number of hours and days initially set for the gradual return process will is set by the physical and mental demands of the job which manager know well. It also depends on how serious the health condition is and the length of absence. Consider also other elements such as the length and type of journey to and from work.
Consider also other elements such as the length and type of journey to and from work.
Once you and your worker agree the phased return, schedule in regular reviews meetings. See Table 1.
It is important you both agree on progression through the programme. Increasing hours of work without a review of progress could result in a relapse as recovery might stall.
In some cases of long-term absence workers lose self-confidence or self-esteem; in this case consider encouraging visits to work before starting the phased return, for coffee or lunch before the first day back. Many workers have told me how daunting the first day is after a year off sick. Many things will have changed as well as team members and if the worker knows this in advance it takes away the sleepless night before day 1.
Reduced hours per day
Workers may lose physical and mental stamina after a serious illness. Some worry about whether they can manage a full day. Others don’t realise how much fitness they have lost by being ill. Offering reduced working hours per day allows workers to return to work early because a shorter day gives a taster of being back at work without the full day to work through and so a more achievable goal.
Increasing Hours of Work
Increasing the hours of work from the start point can be done in 2 ways.
- Increase number of days on site/working
- Increase number of hours worked on site/worked per day.
Also, consider regular increases on a staged basis. Each stage consists of one or two weeks but really depends on the workload and the workers’ response. If possible, encourage a regular increase of 3-5 hours of work per stage. And always suggest that you are available if experiencing problems.
Progress is often rapid in the early part of the rehabilitation programme but can slow down if recovery stalls.
Reduced Days Worked – Non-consecutive day working
Phased returns involve returning to work at a point agreed between the organisation or manager, worker and GP. It depends on the level of fitness when returning.
The idea here is to offer the worker a longer recovery time between work shifts. This helps avoid over exertion and minimises a relapse. Workers who lack confidence in their own capability to return to work benefit most from this approach. It also prevents the over-confident from pushing themselves too early.
This programme is especially helpful for building up to work that requires large amounts of physical or mental stamina.
The number of days worked should increase smoothly over a time. Consider whether home-working would help the worker, especially between site-attendances if they travel a lot. Home working offers more flexibility as it reduces travelling time. Many believe it to be less stressful too.
- The start back to work depends on length of absence and extent of incapacity
- Most people start at Stage 2-3
- A stage is generally a week, though 2 weeks per stage is often useful
- Difficulty at any stage means you should maintain it for another week and consider reassessment of the phased return
- If it goes well, move up a stage
- A really good response means you can move up 2 stages
This article has outlined why and how you should deal with a phased return to work. There are obvious advantages such as early return, increased morale and retention of staff. There could be safety issues, making a phased return to work untenable. Or the worker’s recovery might not go to plan. Or issues with knowing if what you are doing is right or safe.
I believe that managers are able to deal with phased returns to work. There is a lot of information and services available to them. However, this can take up precious time. Why not hire your own occupational health services which could be more cost-effective. It will also give a good return on investment.
- The HSE has examples of written policies, resources for managers and advice on sickness absence issues and how to prevent job loss
- The Chartered Institute of Personnel Development has published a free resource titled Manager Support for Return to Work Following Long-Term Sickness Absence
- The Fit Note Guidance for Employers:
Also on This Website:
- What is occupational health – a short video explaining occupational health’s role
- Bradford index – a means of measuring the impact of absence
- Return to work interviews
- How to do meaningful referrals to occupational health
- An excerpt from “The Managers Ultimate Guide to Health and Wellbeing at Work” available from Amazon